Client Education

Care Planning

Getting Mom's House in Order

By: Dennis Arp, Special to AccentCare

So little time, so much to do.

You have a week’s vacation to fly thousands of miles, get Mom’s household in order, update her care needs, consider modifying her house to ensure her safety and at the same time allay your fears about her continuing to live at home on her own.

Can’t be done?

You might be surprised.

A week is at least enough time to thoroughly review Mom’s situation and get started on changes that might be required. Don’t let the size of the overall project paralyze you. Whether your mom needs 24-hour care and a dozen home modifications or just a little help with bathing and some extra lighting in the hallway, chances are you’ll find the resources to help you tackle the tasks one at a time.

And remember that helping Mom remain in the comfort and familiarity of her own home is a worthy pursuit. Studies show that such seniors enjoy longer, richer and healthier lives than those forced to relocate.

Getting Your Own House in Order

Often the best first step in helping Mom is to help yourself, geriatric care experts say. They advise that with your own house in order, you’ll feel less burdened about taking on Mom’s problems. Think of it as if you were on a plane and the cabin pressure changed. You’d want to put on your own mask before assisting Mom with hers. The advice in this article reflects the input of geriatric care managers, home-care experts, contractors and financial planners.

Organization is vital, especially when you’re monitoring Mom’s care from afar.

• A month before you get on the plane, make appointments with Mom’s doctor, accountant, lawyer, case manager or other professionals you’ll want to meet with during your visit. Record them on a calendar or a day planner.
• Prepare a list of questions for all conversations with care professionals. Take notes.
• Make a list of goals for your visit. Prioritize them. Reward yourself when you’re able to check one off.
• Prepare separate folders on each element of your mother’s care – "Medical Information," "Financial Papers," "Mom’s Friends and Neighbors," etc. Don’t forget to bring the files when you visit.
• Make a list of all the phone numbers that pertain to your mother’s care. You may have so many that you’ll need a directory, but keep it separate from the one you maintain for yourself. This will add convenience and avoid confusion.

When you visit your mom, be acutely aware of her health and her surroundings. Is she alert or lethargic? Is she steady on her feet? Does she tire easily? Is her refrigerator well stocked? Is the food fresh? Is the house clean? Is she attending to personal hygiene? Is she paying bills on time? Is there evidence of abuse or neglect?

As you talk to Mom about what she can and can’t do, ask open-ended questions rather than those that can be answered with "yes" or "no."

"If you say, ‘Have you eaten?’ of course she’ll say, ‘yes,’ because she doesn’t want you to worry," said Donna Minor, a family consultant with the Orange Caregiver Resource Center in Fullerton, Calif. "Instead ask, ‘What time did you eat breakfast?’ Then look for evidence – dirty dishes and so forth."

The answers to these and other questions will help determine what assistance Mom needs.

Before you formulate a care plan, it’s vital to have a handle on Mom’s goals as well as your own. Sit down with your mother and determine what’s most important to her. Her goals may have changed since the last time you spoke.

She may be frustrated because she can’t get out to tend her garden. A simple modification to the back stairs might do wonders for her mental outlook.

"Whenever possible, you don’t want to take away independence," said Carol Marshall-Shoup, director of Care Coordination for AccentCare. "If you’re helping Mom dress, find out whether she likes to start at the top or the bottom. Do things her way, not yours. Let her know she still has choices."

Depending on the complexity of your mother’s finances, you might want to meet with a financial planner or an attorney well versed in estate planning. But even if her holdings are minimal, you’ll want to see that her legal documents are in order.

These should include:

• A durable power of attorney. This will allow a designated person to make financial and housing decisions for Mom, should she become unable to make them for herself.
• A valid will. When was the last time Mom updated hers? Make sure the document still reflects her wishes.
• Advance directives. These could take the form of a living will or a durable power of attorney for health care.

These and other important documents – financial records, business contracts, the deed to the house, insurance policies, etc. – should be stored in a vault or fire-proof box. If Mom has them in a safe-deposit box, make sure you know where the box and the key are.

You may want to set up your own appointment with your mother’s doctor, rather than just accompany her to an exam. This will allow you to freely discuss concerns about her health or treatment.

• Prepare a set of questions before the meeting. Take notes and later transcribe them, if necessary.
• Keep detailed records. Maintain a list of all Mom’s doctors, their addresses and phone numbers. Also note the dates and reasons for any hospitalizations.
• Keep a list of all Mom’s medications and dosages, as well as when she began them. You’ll also want to note any allergies or side effects she has experienced.
• Ask the tough questions, but treat the doctor as a teammate. He or she can be a powerful ally in Mom’s care.

If your mom takes several medications, you’ll want to monitor her compliance. Here are some tips to help her stay on schedule:

• Put the prescription bottle next to something she does routinely. If her antibiotics should be taken with food, set them in a prominent place in the kitchen. If another should be taken at night, set the bottle next to her toothbrush. If young children are sometimes in the house, make sure the bottle is out of their reach.
• If she’s taking tablets three or four times a day, ask her doctor if the medicine would be just as effective in once-a-day dosage. Fewer doses mean fewer chances to forget.
• Divide the squares on a calendar into a grid, with each smaller square representing a medicine she takes. Have Mom or whoever will be monitoring her care check the square each time she takes the medicine.
• Get a large pillbox with compartments for various times of day and each day of the week.

Chances are, friends and neighbors will be glad to help you keep tabs on your mom once you leave.

• Keep a list of the names, addresses and phone numbers of all the friends you enlist.
• Keep the tasks small and spread them around.
• Designate a time and day when you will call to see how Mom is doing.
• Give a key to your mom’s house to a neighbor she and you trust. Ask if that neighbor’s house can be the place Mom would go in case of an emergency.

It’s important to have a plan of care – a day-by-day, sometimes hour-by-hour guide of what needs to happen to maintain Mom’s health and well-being. This Web site has its own free assessment tool that takes about 30 minutes to complete and then generates a plan specifically designed for Mom’s care.

In addition, most communities have geriatric care managers who will help assess Mom’s situation and prepare a care plan. The initial assessment can cost several hundred dollars but may be well worth the expense.

For a monthly fee, care managers can also screen, arrange and monitor in-home services such as meal delivery, adult day care, transportation, nursing and home health aides, for assistance with cooking, cleaning, bathing, etc. They’ll report back to you and other family members. They also know what financial assistance may be available.

Before preparing your own plan, check with the local agency on aging to find out what services are near your mom. If you’re unsure how to get in touch with the bureau on aging in your mother’s area, call the Eldercare Locator at (800) 677-1116. It’s a public service of the U.S. Administration on Aging that will put you in touch with the agency nearest your mom.

For information on care managers, call the National Association of Professional Care Managers at (520) 881-8008. Or visit the group’s Web site at www.caremanager.org.

Part of Marshall-Shoup’s job with AccentCare is assessing seniors’ abilities and limitations and then recommending ways to make their homes safer and more livable. Before the first time she approached the task, she spent half a day just sitting in a chair by herself.

"I put myself in the place of someone who had difficulty getting around, and every time I wanted or needed something, I wrote it down," Marshall-Shoup said. "Then I had to figure out a way to get it. When I had to go to the bathroom, I figured how I would get there and where I would need grab bars. When I wanted a cup of tea, I had to figure the easiest way to get it."

This exercise can help build empathy for Mom’s situation before you consider changes to her home. It also helps, of course, to watch as she goes through her daily routine so you can better understand her situation.

Again, a care manager can offer suggestions on how to make Mom’s home safer and more accessible. A manager may also know of contractors in the area who specialize in home modifications for seniors. Costs can range from less than $100 for small jobs, like the installation of grab bars, to $3,000 to $5,000 for major changes throughout a house, said Dan Leary, owner of Home Access, a San Francisco Bay Area company that specializes in home modifications.

Medicare may pay for some modifications, if you can adequately show medical need. If Mom has secondary insurance, check with the company’s benefits representative.

"Even if you get denied, you can still appeal and sometimes eke something out," said Anita Aymar, a nurse consultant with Home Access.

Following are some safety and accessibility tips for helping Mom feel safe at home:

This is a key concern, because the eyesight of many seniors is declining.

• Make sure lights are strong and glare is minimized, particularly in high-traffic areas such as entries and hallways.
• Each doorway should have a light switch, and another should be reachable from bed.
• Place flashlights in the bedroom, kitchen, living area, etc., in case of a power failure. Check the batteries periodically and replace them when needed.
• Equip halls, bathrooms and the kitchen with nightlights and/or motion-sensitive lighting.

About 30 percent of those older than 65 fall each year. It is the sixth leading cause of death among this age group, according to a 1994 report in the New England Journal of Medicine.

• Eliminate throw rugs. Also clear pathways of small items such as wastebaskets, electrical cords and doorstops.
• Replace longer-pile carpets with shorter, denser options. Choose a thick underpad to cushion a fall.
• Avoid slick, highly polished floors and surfaces.
• Make sure everyday items are stored within easy reach in cabinets, closets, pantries, medicine chests, etc. Anything that forces Mom to use a step stool or ladder is a safety hazard.

• Because the sense of smell declines with age, working smoke detectors are even more important in a senior’s home. Install them in each bedroom and near the kitchen. Make sure there is at least one on each floor. Change the batteries at least once a year. Link this task with a memorable date, such as Memorial Day or Labor Day, so you don’t forget to change them, whether they seem to need it or not.
• Determine a workable escape route. Remember to fully consider Mom’s physical limitations.
• Put a small fire extinguisher in or near the kitchen and help her learn how to use it.
• If Mom is immobile, notify the local fire authority, which can advise you on such special circumstances.

• Program phones with emergency numbers or post them prominently by each extension. Include your number and that of a nearby friend or relative as well as those of the police and fire departments and ambulance company.
• Make sure Mom carries a medical ID card or wears a tag with information on preconditions, blood type, etc.
• Consider getting a medical alert device, which allows Mom to summon help with just the push of a button. You may decide the monthly expense is more than offset by the peace of mind it brings, especially if Mom lives alone.

• Make sure all windows and entry doors have locks. The front door should have a deadbolt that can be operated easily and without a key. However, a deadbolt may be difficult for Mom to use if she lacks dexterity. Slide bolts are much easier to operate and provide a high level of security.
• Install a peephole in the front door at a level appropriate for Mom. Remind her not to open the door to anyone she doesn’t know.
• Consider getting a home alarm system.
• Talk to the local police about whether Mom’s neighborhood is safe for walking and what routes would be best. The department may also offer seminars with other tips on security for seniors.

• If the level of the threshold changes more than 1/2 inch, it’s a tripping hazard. Ramp it or remove it.
• A doormat can also expose Mom to the risk of a fall. Remove it, recess it or, at the very least, secure it with two-sided tape.
• For easier clearance, consider installing offset hinges. They enlarge the opening by the width of the door, which might be enough for a wheelchair to get through.
• In some instances, you might find it’s easier to just remove an interior door and take advantage of the added clearance.

The danger of falls is greatest in this room. It’s also the room where dignity issues become paramount. "Clients are so happy when we’re able to make changes that allow them to bathe or go to the bathroom by themselves," said Leary of Home Access.

• Make sure Mom has a nonskid bathmat and a nonslip mat or strips in the tub or shower.
• Install grab bars near the tub and toilet.
• Install a transfer pole and raise the toilet or seat to make it easier to get on and off.
• Put a seat or bench in the shower or tub.
• Replace a glass shower door with a plastic one. If the bathroom has a shower curtain, make sure it’s hung on a secure rod and not on a tension one.
• Consider installing a hydro tub, which has sides that open to the floor so a wheelchair can roll right in.
• Despite its name, don’t store medicines in the medicine cabinet. The heat and moisture of the bathroom can hamper their effectiveness. Store them in a dry, cool spot – such as a kitchen or pantry cabinet.

• Make sure dishes and utensils are stored within reach.
• See to it that the transfer of food from kitchen to table is as easy as possible. You may want to put a small table in the kitchen or get Mom to use a cart for transporting dishes to the dining room.
• Get Mom to date food before she stores it in the refrigerator. Masking tape and a felt-tip pen will do the trick.

• Arrange furniture to allow for a clear walking path.
• Make sure chairs are the right height to allow Mom to sit and stand easily. They should also have strong armrests and backs so she can lean on them for support.
• Repair or discard wobbly furniture. Avoid three-legged tables.

• Keep a light and phone within easy reach of the bed.
• If Mom’s bed has wheels, make sure they are locked.
• Install a rail or grab bar next to the bed.
• Make sure the nightstand is sturdy.
• Arrange closets so clothing is staggered and at reachable heights.

• The first option should be to avoid them completely. Consider turning a downstairs den into a bedroom, if necessary. Ramps and lifts can be installed but sometimes are expensive.
• Be sure handrails are sturdy and are placed on both sides of the stairs.
• Use brightly colored tape to line the edges of steps.

All home-modifying work and no play makes for a dull trip. Take time each day of your visit to do something you and Mom enjoy. Go to lunch, see a movie, take her shopping or to get her hair done. You’ll both feel better about the overall experience.

Don’t feel bad if you didn’t accomplish all your goals during the visit. Take pride in what you did achieve. When you get home, you’ll have all the file folders you made during your trip, and you’ll be ready to follow up on any unfinished projects.

Now relax. Your concern has helped make Mom safer, more secure and, chances are, happier in her own home. Your worry won’t do either of you any good.

Dennis Arp is a freelance journalist who writes about health-care-related issues for newspapers, magazines and the Web.